Provider Demographics
NPI:1770327579
Name:KOUROSH MEHRABIAN DDS & ASSOCIATES
Entity type:Organization
Organization Name:KOUROSH MEHRABIAN DDS & ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KOUROSH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHRABIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-608-9800
Mailing Address - Street 1:923 RUSSELL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-6224
Mailing Address - Country:US
Mailing Address - Phone:240-667-7615
Mailing Address - Fax:
Practice Address - Street 1:923 RUSSELL AVE STE A
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-6224
Practice Address - Country:US
Practice Address - Phone:240-667-7615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty